Restructuring of HR Practices in NHS: A Case Study of Oxleas NHS

Human resource management (HRM), otherwise known as Human Capital Resources (HCR), is undoubtedly a very important segment of organisational management that must be properly administered to enable any organisation meet its target objective. It is on the basis of this that researchers are becoming increasingly interested in examining the HRM as the link between human resource policies and unit performance [1]; Wright and McMahan [2]. That is why the human resources team has a major role to play in maintaining the high standard of service especially in large and complex organisations. The UK, National Health Service (NHS) is not an exception.


Introduction
Human resource management (HRM), otherwise known as Human Capital Resources (HCR), is undoubtedly a very important segment of organisational management that must be properly administered to enable any organisation meet its target objective. It is on the basis of this that researchers are becoming increasingly interested in examining the HRM as the link between human resource policies and unit performance [1]; Wright and McMahan [2]. That is why the human resources team has a major role to play in maintaining the high standard of service especially in large and complex organisations. The UK, National Health Service (NHS) is not an exception.
Most studies on HRM have been focused on business and profit making firms. Less attention is paid to non-profit and public service corporations, especially the health sector about which the public has always been complacent. Stefane et al. [3] highlights the significance of human resources in healthcare. They argue that human resources are one of the three major health system inputs that must always be considered in strategic health planning. Physical capital and consumables are the other two inputs which are complementary to HRM. It has become pertinent therefore to explore the impact of HRM on healthcare and the need to reform and restructure the human resources in this important industry.
Suffice here to say that the success of any organisation rests mainly on the staff members that make up the entire organisation. From the lowest to the highest cadre, every member of staff has a role to play in the overall well-being and the general output of the organisation. Besides, as the concept and practice of employee-employer relationships have also undergone a change over the years, the role of the HRM in the modern time has gone beyond hiring and firing of staff only. HRM has dramatically evolved in a way that it now constitutes the cornerstone of most organisations with reasonably large number of employees. This development has made HRM assume a position of central importance in the organization especially since any decision and or process of an organization must be implemented by the people who make up the organisation itself [4].
As a follow-up to the above, Cristina [5] explores the possible links between HRM and individual as well as business unit levels of performance. She adopted this approach in reaction to some authors who express reservation about the single-respondent organizational surveys (SROS) which are widely used by researchers to collect data relating to HRM. Those authors therefore call for the use of alternative methodologies, such as case studies, so as to test for overgeneralisations regarding SROS-based findings. Despite raising some challenging questions, she agrees that HR policies definitely have an impact in overall firm performance.
In view of this, one would not be wrong to assert that Human Resources Management occupies a very vital position in the overall performance of any organisation. According to Richard Rubin [6] a well-managed human resources department usually results in a very high care environment among team members. This positively impacts on both the transfer and the creation of knowledge and experience within the team.

Oxleas NHS foundation trust: Background information
Oxleas is one of the most successful healthcare organisations in the south east of England. The trust came into being in 1994 as a local Community Trust in Bexley. It assumed the name Oxleas in 1995 after the ancient Oxleas Woods in Dartford which is located at the borders between Bexley and Greenwich and continues to be a central point to the areas in which the trust provides care. With passage of time, it became widespread and specialised. It is focused on providing mental health and adult learning disability services.
Oxleas gradually expanded beyond its original birth place to neighboring areas. For instance, it took over Greenwich and Bromley mental health services in 1995 and 1997 respectively. Other areas of service covered by Oxleas now include child and adolescent mental health, adult learning disability services, prison services, physical health services to adults and children in the community among other relevant services [7].
By and large, Oxleas has made outstanding success in its contribution to health and social care, especially within the boroughs of Bexley, Greenwich and Bromley. In an NHS staff survey carried out in 2008, Oxleas was rated the best or second best among all the mental health trusts in 15 different categories. The Care Quality Commission (CQC) consistently rates Oxleas NHS Foundation Trust as excellent or good and most of its wards and units meet the expected standards (CQC). In 2009, the Royal College of Psychiatrists rated Oxleas as the best mental health services provider [8]. All these achievements would not have been possible without the commitment and professionalism of the managers and employees of the trust who work together hand in gloves to provide the best services to the service users.

Human resources at Oxleas
The history of human resources management at Oxleas is that of

Abstract
The aim of this paper is to evaluate the Human Resources department of Oxleas NHS Foundation Trust and see whether there is need to restructure the organisation's HR practices. A review of the trust's HR management system is carried out to determine how it has impacted on the overall performance of the organisation. Efforts shall be made to identify areas where improvement can be made so as to enable the trust to compete more effectively in the current competitive market environment. out on a regular basis to determine the number of vacancy that exist within a particular department, ward or unit. It is also the responsibility of each manager to notify the HR department of any vacant positions available within his area of operation. Basically, the manager sends the information about the staff vacancies to the directorate. Then if the directorate is happy with the staff request, the message is passed on to the HR department for further consideration and approval. Vacancies approved by the HR department are eventually forwarded to NHS job websites for advertisement.

International Journal of Economics & Management Sciences
Be that as it may, we need to point it out here that reaching potential and prospective employees is a very arduous task. Therefore, effective and ultra-targeted marketing must be employed to reach the most qualified candidates that are best suited for the vacancies available to be filled. Oxleas management therefore prefer to give this task to the NHS Jobs. This is the dedicated online recruitment service for the entire NHS in England and Wales. Through its online portal, the organization publishes approximately 20,000 job opportunities monthly. Not only that, it also attracts over 6 million visits to its web pages and processes over 250,000 applications received from jobseekers on a monthly basis. While NHS Jobs carries out the collection and processing of applications, the HR department at Oxleas completes the final selection processes.
Another method adopted by Oxleas for staff recruitment is via internal vacancy advertisement. This is a way of restricting certain job opportunities only to candidates who are already working for the trust. This gives every staff the opportunity to aspire to higher positions without any need to resign from the current position. It also reduces employee' turnover as the employees do not have to go elsewhere to look for a greener pasture. This system also creates an open recruitment process which can serve as a paradigm for equal opportunity. But the disadvantage of the system as Susan et al. [11] posits is that it is not foolproof. This is because hiring decision might have already been made before the job is posted and this can make the whole process lose it credibility.
Oxleas also uses some indirect methods to recruit staff to fill vacant positions. This is done by employing the services of some employment agencies to fill some ad-hoc or short term positions. Some positions are only open for a short time. Examples of these are the vacancies resulting from maternity of paternity leave, leave of absence, secondment, sabbatical leave, sickness and other similar conditions. Owing to the high number and frequency of these type vacancies, it may be too cumbersome for the HR department to fill those positions through direct employment. That is why employment agencies that specialise in this type of recruitment are normally used for this purpose. Middleton Murray is the favorite agency that Oxleas uses for this purpose.
Using recruitment agencies to fill job vacancies can be beneficial to the employer.
For instance, a professional head hunting company can provide a list of highly qualified candidates within a very short time, thereby saving a lot of time and hassle for the employer. It can also negotiate bulk discounts in advertising on behalf of its client. An employment agency can also help improve an advertisement by providing professional guidance for the employer.
But the method is not without demerit. Its major drawback is the cost. Most of the time, it is very expensive to use head hunters to fill vacancies because of the exorbitant fees charged for the services it provides. Its negative impacts on the employee are that most of the a success. There is no gainsaying the fact that the trust's achievements mentioned above cannot be detached from the professional management of the human resources. As stated in the Trust's staff handbook, Oxleas recognises the fact that it could only achieve its target objective if it has sufficient staff, with the right skills, expertise, experience and competencies and feel motivated and valued. That is why the HR department is always striving very hard to improve the working lives of the entire staff.
Oxleas, has proved itself as a mindful employer by using mutually beneficial methods in the selection and management of its staff. To this end, only people that share the trust's values recruited into its work force. The trust's values as illustrated in its staff handbook include, this is very necessary in order to bring like-minded people to work together as a team without jeopardising its central principle of equal opportunity during the staff recruitment and selection processes. The same principle is applied in staff development, progression, incentives, and reward.
As of the time of writing this report, Oxleas had about 3,300 employees. These are divided among different departments and units within the organisation with nursing forming the largest group constituting 53% of the trust's workforce. All the employees work hand in hand and they all interact and cooperate with each other for the common goal of the organization.

Recruitment and selection
Oxleas is very passionate about quality and professionalism when it comes to selection and recruitments. This is carefully done with great consideration to fairness and minimisation of all sorts of discrimination except where positive or necessary.
There is no gainsaying the fact that healthcare professionals are in very high demand in the modern day Britain. The spectacular successes and breakthroughs made in the medical science enable people live longer than before [9]. In view of this, the ageing population require more nurses, doctors and other allied health professionals and support staff to cope with the high demand of manpower in the health sector. Thus, the higher the population, the more health workers are required to cater for the health needs of the people.
Against the backdrop of Francis [10] report into the failings at Mid Staffordshire NHS Foundation Trust and its description of care in the NHS as being in a very awful state of affairs, managers of the Oxleas NHS Foundation recognise the need to improve on the services provided to the patients at all times. Despite all the achievements the trust has made, there is still no room for complacency and there would never be.
As expressed in Francis report mentioned above, the overall goal of providing excellent service to patients cannot be achieved without the efforts of the caring, compassionate and committed staff, working to a common culture. That is why the report recommends that healthcare workers should always be prepared to comply with the standard procedures in their places of work. It is in view of this that Oxleas managers ensure that they employ only the staff that can apply the trust's values in all their work.
Owing to the shortage of healthcare professionals, virtually all healthcare service providers find it very difficult to fill all the vacancies available in their organisations as demand far outstrips supply. To get around this, it is very vital to devise strategies that will ensure adequate supply of quality staff at all times. To achieve this, staff auditing is carried jobs offered through agencies are temporary and the fees charged to the employer may reduce the overall take-home pay of the employees Stephen [12].
Sometimes, some positions need to be filled quickly and on emergency basis due to excessive workloads, time out, sickness, absence etc. This is more relevant to the nursing positions. It must be noted that nurses constitute 53% of the entire Oxleas staff force making them the bulk of the trust's employees. And because of the nature of their work which involves 24 hours direct service to patients, they need to be available at all times. This fact is corroborated by the Francis report quoted above.
On a regular basis therefore, temporary staff are required to cover shifts lasting approximately 8 hours without necessarily being employed on a permanent basis. Most organizations use recruitment agencies to hire temporary staff. However, in a recent study on the cost of hiring temporary nursing staff, Hurst and Smith [13] discovered that wards that use both temporary and permanent staff together were more expensive to run while the working styles were quite different.
Oxleas found a way of getting around this. A temporary staffing office was created (TSO) with the responsibility to provide temporary staff to wards, units, homes and similar premises due to staff shortages occasioned by vacancies, sickness and other unavoidable situations. A centralised system was therefore created for the management of Temporary workers and ensure the induction and training, accountability and monitoring of temporary workers.
The TSO uses a system called The Bank. Through the system, several qualified workers are employed on a zero hour contract which stipulates that the employer is not obliged to provide any work to the employee and the worker is only paid for the work actually done on a pro rata basis [14]. The Bank has been a significant source of staff intakes for emergency cover.
One can say without mincing words that Oxleas methods of staff recruitment are very fair, efficient and cost effective. But these methods are not without their drawbacks. For instance, by using only the NHS jobs for advertising and outsourcing, the trust misses out on many ways of reaching potential staff using modern technology and strategies. Open days, Job Centre Plus, News and Print Media advertising, social media and online marketing and other similar methods are some of the other ways through which prospective workers can be reached. Similarly, the HR can organise visits to colleges and universities to intimate students of employment opportunities available for them after graduation. Conditional or provisional job offers may even be granted to extra brilliant students, especially those with a first class or second class upper division to stimulate their interest in joining the trust. Similar visits may be paid to secondary and grammar schools to encourage pupils to choose careers in nursing, medicine, psychiatry, social work, occupational therapy and similar professions.

Staff management
As already mention above, staff management is as important as recruitment. In view of this, the top managers at Oxleas realise the tasks before the HR department. That is why the department is given reasonable autonomy to enable it carry out its task effectively. The HR reports directly to the Chief Executive as reporting to any level other than the executive is consider inappropriate [15].
Promoting the values of the trust is not limited to recruiting staff that share those values alone. It also involves constant direction and training towards those values. These values are discussed during the induction process and frequently reiterated to the existing staff. It becomes the responsibility of the HR to see to the realisation of this objective. With proper supervision, staff monitoring, staff development and training, the likelihood of achieving this objective is very high.
One of the methods used in this regard is segmented supervision. This is done by decentralising the supervision process whereby staff members are continuously supervised at various levels commensurate with their areas of operation. Managers are saddled with the responsibility of supervising the staff working under them. To commemorate this, lead nurses are appointed at every directorate with the responsibility to oversee the appraisal and supervision systems for nursing staff since nurses form the largest group among Oxleas workforce [7].
Staff performance is also evaluated through feedback from patients and service users. The HR has various robust ways of gathering information from patients. These include annual patient survey, telephone surveys, and an internet portal called ResearchNet. A patient experience dashboard is also created to showcase the performance of each team against certain agreed indicators [7]. All the efforts carried out by the HR gain support at the top management level. Everyone is involved. The trust's directors visit each service area within the directorates so as to meet staff and patients and discuss key issues.
The HR uses other means such as regular staff meetings, away days, internal memo and regular reviews among other things to get feedback from staff, evaluate their works and map out strategy for improvement. The HR department also employs the modern technology in its human capital management. Mention must be made of RIO, Digipens, iNurse and Telehealth. RIO is the electronic patient information system that the staffs use to enter the records of their daily workloads and progress notes regarding services rendered to the patients. Digipens look like norman pens and enable community nurses write their notes as they would do with normal pens. Back at the office, they can dock their Digipens on their computers and the information on the pen is automatically uploaded to RIO. The purpose of the iNurse is to enable staff use their tablets to access information directly from RIO [7]. Telehealth is the equipment installed in patients' homes to enable clinicians monitor their health remotely without making a home visit.
Another programme that deserves mentioning here is the productive ward and the Care, Compassion and Engagement (CCE) project. The main objective of the project is to improve ward processes and environments so as to enable staff spend more time on patient care. A lot of efforts are directed to this project and its positive impacts on patient care are acknowledged by both staff and patients. All these efforts are not without their challenges. The most important of these challenges is negative attitude to change. Some employees find it difficult to adapt to the new systems seeing them as being problematic and needless. But with time, things will fall into shape everyone will get used to the new way of working.

Staff motivation
In 2010, the Care Quality Commission [16] carried out a National NHS Staff Survey to examine staff satisfaction level in all NHS trusts across the country. Oxleas performance in the survey was staggering. The trust was able to be in the top rank of 23 out of 39 areas covered in the said survey. Commitment to work life balance; support from immediate manager line manager; percentage of staff that feel their role and the opportunity to develop their potential are some of the areas covered in the survey [7]. Be that as it may, it must be stated at the juncture that Oxleas would not have achieved this fantastic level of customer satisfaction if not for its innovative, employee-focused and novel motivational programmes. Some of the programmes initiated to motivate staff include part time hours, unpaid leave and sabbaticals and other flexible w orking opportunities; voluntary pension scheme to which the trust contribute generously (14%); competitive lease car scheme; enhanced maternity and sick leave pay for those who may need it; discounted shopping through certain websites via NHS Discounts; work related healthcare such as vouchers for free eye care checkups; annual staff recognition awards among other benefits.

Conclusions
As can be seen from the foregoing, Oxleas management of its human capital has been very impressive. From fair recruitment to positive supervision and various programmes of staff motivation, the whole system has been that of a success. This has resulted in a very high level of customer satisfaction. One can understand therefore why Oxleas was voted in 2010 as the fourth best NHS organization to work for.
Making this type of achievement and maintaining it is not an easy task. The HR department works very hard with the support of committed staff and directors to undertake the difficult tasks. With the introduction of new technology and adopting new ideas, working at Oxleas has been transformed into brilliant working environment.
Despite all these achievements, there is still room for improvement. For instance, most of the benefits enjoyed by Oxleas staff are not extended to the bank workers. This amounts to discrimination as the bank workers work as hard as the substantive staff. Recognizing the need for improvement, Oxleas Director of Human Resources and Organizational Development, Simon Hart, confirms that the entire staff m embers o f O xleas a re q uite p roud o f t he a chievements m ade by the trust and are determined to strive in the future to provide the patients with the highest standard of care [4].